“Your medication is on back order!” These are scary words coming from my pharmacist. More than once, I’ve felt the effects of Canada’s drug shortage situation. And despite the latest attempts – it seems to keep getting worse.
There has been increased focus on the problem of drug shortages since the heparin incident in 2008. Adulterated heparin was removed from markets around the globe as an appropriate response to protect patient health. However, so much of this life saving medication was taken off the shelves that it was hard to find sufficient replacement medication.
This incident brought to light the precariously fragility of the drug supply chain. Increasingly drug shortages are becoming commonplace. Now, 94 per cent of pharmacies report having difficulty fulfilling patient prescriptions.
The reasons for the drug shortages are many. You can see on the DrugShortages.ca database that drugs are not in supply because of increased demand, manufacturing problems or ingredient availability issues. The new Protocol for the Notification and Communication of Drug Shortages (September 2013), sets out expectations for the notification and communication of information to a drug shortage. With this protocol we will at least know when a drug shortage is anticipated.
However, the Protocol does not and cannot address the real reason for drug shortages in Canada. Drug supplies are market driven. That means that a global drug company will supply its biggest customers first before allocating supply to a 3 per cent drug market like Canada.
Evidence for this is easy to find. Compare the drug shortage list in the United States versus Canada. The US shortages are primarily with generic drugs while in Canada brand name drugs make up a significant proportion of the list. In addition, drugs shortages in Canada often don’t show up as shortages in the US. In fact it is pretty obvious sometimes. One drug is on allocation in the US while it will no longer be offer in Canada. I get it – we are a small market.
That is no consolation when you go to get a refill and get told it is on back order. It has happened to me for my tumor suppressant and coritsol – both of which are pretty critical to my continued existence.
What strategies are available then?
- Don’t wait until you are on you last pill. This gives time for the pharmacy to source other pharmacies for supply.
- You may need to take a different dose. For example, I had to accept a 20mg pill and break it in half and quarter to get my dose. Not ideal – but it works.
- You may need to replace your medication to a different company’s product or alternate treatment. This is easy for generic drugs but may be harder to do for brand name ones. You may need a visit to your physician.
Drug shortages seem to be getting worse. The market dynamics are driving this trend with no end in sight. The single best thing you can do is to renew your prescriptions 10 days before you run out. This hopefully can give your pharmacist and physician, if need be, time to figure out a way to deal with it.